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China consumes over a third of the worlds cigarettes, and has a sixth of the global smoking death toll

21-24 Thus, the use of a pack-year smoking history cutoff to select individuals for screening may exclude many individuals at high risk for lung cancer by underestimating lung cancer risk among those who smoke less intensely (ie, fewer cigarettes per day), such as individuals from racial and ethnic minority groups

The hefty price tag of a pack might be one reason for the decrease

Abnormal M1/M2 macrophage phenotype profiles in the small airway wall and lumen in smokers and chronic obstructive pulmonary disease (COPD)

Rockville, Maryland: Health Services and Mental Health Administration Regional Medical Programs Services